Lung Empyema

Previous pneumonia or thoracic surgery may cause a complication, in which a focal collection of infectious fluid builds up in the pleural space in between lungs and the chest wall. Once accumulated, this infectious fluid does not allow your lungs to inflate as per normal, therefore causing breathing difficulties. This condition is called lung empyema. Most common lung empyema symptoms include chest pain, fever and shortness of breath. Lung empyema treatment aims to remove infectious fluid from the pleural space and eradicate the infection. Below we are going to review this condition, its symptoms, diagnostic services and lung empyema treatment options in more detail.

So, as it has been mentioned about, lung empyema is an accumulation of pus in the pleural space, which is the area between the lungs and the inner surface of the chest wall. Pus is a fluid filled with immune cells, dead cells, and bacteria. Lung empyema, also called pyothorax or purulent pleuritis, may appear as a complication of pneumonia, which is an infection of the lung tissue, or as a secondary infection caused by a surgical intervention, etc. The biggest concern is that pus in the pleural space cannot go away on its own, unless being drained by a doctor. If left unattended, this condition develops and its symptoms become more and more intense.


  • Pain in chest (worsens when you breathe in deeply)
  • Dry cough
  • Sweating excessively (especially night sweats)
  • Fever and chills
  • General discomfort, uneasiness or ill feeling (malaise)
  • Shortness of breath
  • Unintentional weight loss


The goal of the treatment is to remove the pus, drain the fluid from the pleura and treatment of the infection. Underlying infection is treated with antibiotics. Depending on the type of bacteria that’s causing the infection, different antibiotics will be prescribed. Draining the pus is the next step. The method used will depend on what stage the empyema is at.

  • Simple Empyema: A needle is inserted into the pleural space to drain out the fluid in simple cases. This is known as percutaneous thoracentesis.
  • Complex Empyema: A drainage tube is used to drain the pus in later stages. This is normally performed under general anesthesia in an operating room.
  • Thoracostomy: A plastic tube will be inserted into your chest (between two ribs) to a suction device and the fluid will be removed. A medication may also be injected to help drain out the fluid.
  • Open decortication: The pleural peel will be peeled away by your surgeon and this will help prevent permanent disability.
  • Video-assisted thoracoscopic surgery Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used to diagnose and treat problems in your chest. During a video-assisted thoracoscopic surgery procedure, a tiny camera (thoracoscope) and surgical instruments are inserted into your chest through several small incisions. The thoracoscope transmits images of the inside of your chest onto a video monitor, guiding the surgeon in performing the procedure.


  • Physical examination: A complete medical history and physical examination will be conducted. A stethoscope may be used to detect abnormal sounds. Decreased breath sounds or an abnormal sound when listening to the chest may be noted down.
  • Chest X-rays and CT scans: Reveal if there is fluid in the pleural space
  • Ultrasound: To determine the amount of fluid and the exact location
  • Blood tests: To check white blood cell count and C-reactive protein and also to identify the particular bacteria that’s causing the infection. When you have an infection, the white blood count will be elevated.
  • Thoracentesis: A sample of fluid is injected into the pleural space through a needle that’s inserted through the back of your ribcage. The fluid will then be analyzed to search for bacteria, protein, and other cells.